More than half of U.S. jails are located at least a 30-minute drive from the nearest opioid treatment program, according to a study led by researchers at Brown University School of Public Health and published on Apr. 2 in JAMA Network Open.
The findings highlight challenges faced by incarcerated people who need methadone, a key medication for opioid addiction, during their time in jail. The distance to treatment programs may make it harder for these individuals to access necessary care, increasing risks after release.
Researchers analyzed data from 3,228 nonfederal jails and 2,096 federally licensed opioid treatment programs (OTPs). Brendan Saloner, professor in Brown's Department of Health Services, Policy and Practice and lead author of the study, said "Jail has historically been really bad for overdose risk - people go in, withdraw and then come out and overdose." He also said that if problems like opioid use disorder remain untreated during incarceration "we as taxpayers are going to end up paying for it later." Saloner called for efforts to expand access beyond the current OTP model where distance is an obstacle.
Methadone is one of the most effective treatments but is tightly regulated. It must typically be dispensed through licensed OTPs rather than directly within most jails. This requirement creates logistical issues since jail staff often have to travel daily to collect doses from outside clinics. "It's a trip that has to get made every day," Saloner said. "Jail staff have to go out, pick up the methadone and bring it back." He added that expecting every jail to send staff on long drives is not feasible: "That's not a feasible solution."
The study found that rural counties face even greater barriers; there the average driving time was about 85 minutes compared with about 11 minutes in large urban counties. The longest distances were reported in parts of the Great Plains as well as states such as Nevada and Alaska.
Saloner noted that recent federal regulations provide another option: "Jails have the ability to register as a hospital or clinic and dispense their own methadone to qualified patients." He said expanding this approach could help address access issues: "Getting more jails to follow this model could make a huge difference which is why our team is supporting more facilities to adopt this model."
